J Vet Intern Med 2014;28:102108

Arterial Thromboembolism in 250 Cats in General Practice:

20042012
K. Borgeat, J. Wright, O. Garrod, J.R. Payne, and V.L. Fuentes
Background: Population characteristics and outcome of cats with arterial thromboembolism (ATE) managed in general
practice (GP) have been poorly described.
Hypothesis: Cats with ATE presenting to GP are usually euthanized at presentation, but survival times >1 year are
possible.
Animals: Cats with ATE managed by 3 GP clinics in the United Kingdom.
Methods: Records of cases presenting to GP over a 98-month period (20042012) were reviewed. Cats with an antemortem diagnosis of limb ATE were included. Outcome information was obtained.
Results: Over 98 months, 250 cats were identied with ATE. Prevalence was approximately 0.3%. At presentation, 153
cats (61.2%) were euthanized, with 68/97 (70.1%) of the remaining cats (27.2% of the total population) surviving
>24 hours after presentation. Of these, 30/68 (44.1%) survived for at least 7 days. Hypothermia (HR, 1.44; 95% CI,
1.0022.07; P = .049) and management by Clinic 2 (HR, 5.53; 95% CI, 1.2324.8; P = .026) were independent predictors
of 24-hour euthanasia or death. For cats surviving >24 hours, hypothermia (HR, 2.25; 95% CI, 1.124.48; P = .021) and
failure to receive aspirin, clopidogrel, or both (HR, 8.26; 95% CI, 1.3950; P = .001) were independent predictors of
euthanasia or death within 7 days. For cats that survived 7 days, median survival time was 94 (95% CI, 42164) days,
with 6 cats alive 1 year after presentation.
Conclusions: Although 153/250 cats were euthanized at presentation, 6 cats survived >12 months. No factors were identied that predicted euthanasia on presentation.
Key words: Cardiology; Cardiovascular; Clinical Epidemiology; Feline.

rterial thromboembolism (ATE) is a condition

associated with high morbidity and mortality in
cats, most commonly with an acute and distressing
presentation. For clinical purposes, it is often dened
as thromboembolism to 1 limb. In most cases, the
thrombus originates in the left side of the heart.
Although pulmonary thromboembolism also involves
arterial occlusion, it is usually classied as a separate
syndrome.1 Presenting signs of limb ATE are easily
recognized. Loss of peripheral pulses, tissue pallor,
lower motor neuron signs, and cool extremities in the
presence of neuromuscular pain provide a highly
suggestive clinical picture.2,3 Smith et al reported that
1/175 (0.006%) of their hospital feline population presented with ATE,4 a similar prevalence to 1/142 cats
(0.007%) reported by Buchanan et al from a dierent
center, almost 40 years earlier.5 These data were
obtained from cats treated in referral practice and do
not necessarily represent the general feline population.
Feline ATE is most commonly associated with cardiomyopathy, although cardiac disease is not present in
all aected cats.413

From the Royal Veterinary College, Hatfield, Hertfordshire, UK

(Borgeat, Payne, Fuentes); the Zetland Veterinary Group, Redland,
Bristol, UK (Wright); and 1 Merioneth Street, Victoria Park,
Bristol, UK (Garrod). Meeting at which the paper was presented:
ECVIM-CA Congress, Maastricht, September 2012.
Corresponding author: K. Borgeat, Royal Veterinary College,
Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9
7TA, UK; e-mail: kborgeat@rvc.ac.uk

Submitted November 23, 2012; Revised August 9, 2013;

Accepted September 26, 2013.
Copyright 2013 by the American College of Veterinary Internal
Medicine
10.1111/jvim.12249

Abbreviations:
ATE
GP
UK
HR
95% CI
CHF
MST

arterial thromboembolism
general practice
United Kingdom
hazard ratio
95% condence intervals
congestive heart failure
median survival time

It is widely acknowledged that ATE has a poor prognosis, although, to the authors knowledge, no prospective studies have reported the outcome of cats presenting
with acute clinical signs. Several retrospective studies
suggest that euthanasia at presentation is common and
<50% patients survive to discharge.4,68,14 Smith et al
reported that hypothermia, 2 aected limbs, absence of
motor function, hyperphosphatemia, and bradycardia
were associated with a decreased rate of survival to discharge.4 Moore et al also reported that hypothermia
and 2 aected limbs were associated with death or
euthanasia before discharge.8 It has been suggested that
cats in congestive heart failure (CHF) have a shorter survival time after discharge.4 Among cats discharged from
the clinic, recurrence of ATE is common.46,8
Cats with ATE presented to general practice (GP)
veterinary clinics have been under-represented in the
literature.7 We aimed to analyze the patient characteristics and outcome in a population of cats managed in
GP and to estimate the prevalence of ATE in cats in
the United Kingdom (UK) GP. We hypothesized that
cats with ATE presenting to GP were likely to be
euthanized at presentation without any attempt to
treat the disease, but that survival times >1 year were
possible for some cats.

Arterial Thromboembolism in 250 Cats

Materials and Methods

Two large practices and 1 emergency only, out-of-hours,
clinic took part in the study. Both the 2 nonemergency practices
consisted of a central hospital providing 24-hour care with 4
(Clinic 1) and 6 (Clinic 3) smaller branches. This is a common
model of private practice in the United Kingdom. Across the 3
clinics, no more than 8 of 40 veterinarians at any time were
known to have held a postgraduate Royal College of Veterinary
Surgeons (RCVS) Certicate, with only 3 Certicate-holders in
either Cardiology or Internal Medicine. One practice (Clinic 1)
listed a total of 7 visiting RCVS or European Diploma holders
during the inclusion period, with only 1 Cardiology and no
Internal Medicine Specialists. Computerized records were maintained in each clinic and stored on a centralized database in
each practice, from which the record text could be searched and
records retrieved for manual review. Electronic patient records
from each of the 3 centers were retrospectively reviewed and
searched for terms relating to ATE in cats presented from
January 1, 2004 to March 1, 2012 inclusive. The search terms
used were as follows: arterial thromboembolism, aortic
thromboembolism, ATE, FATE, arterial thrombus,
aortic thrombus, arterial clot, aortic clot, saddle clot,
hind limb paralysis, o back legs, aspirin, clopidogrel,
and heparin. Individual records were manually reviewed by a
single operator (KB). Cats were included if they presented with
typical clinical signs of limb ATE. Cases were excluded if they
had atypical signs, were dead on arrival, had clinical signs suggestive of nonlimb ATE, or had a diagnosis made postmortem.
Cats that were referred from Clinics 13 to another specialist
referral center for treatment of their ATE were excluded.
Medical records of cats with ATE were reviewed for date and
age at presentation, sex, breed, and the time between the onset of
clinical signs and presentation. The time of presentation to the
clinic was dened as out-of-hours (yes/no), referring to a consultation outside of clinic working hours as an emergency patient.
Physical examination ndings were recorded, including number
of limbs and which limbs were aected. Wherever laboratory
results were available, the serum concentrations of urea, creatinine, phosphate, and potassium also were recorded. Details of
previously auscultated abnormalities or any pre-existing diseases
were recorded. CHF was dened as any one of the following:
presence of radiographic evidence of pulmonary edema, ultrasonographic evidence of pleural eusion with concurrent cardiomegaly or left atrial dilatation, presence of pulmonary crackles in
a dyspneic patient that subsequently responded to furosemide
therapy, or uid reported from the nose or mouth after euthanasia. Tachypnea, dyspnea, pulmonary crackles, or left atrial dilatation alone was not a sucient criterion for the presence of CHF.
Mortality was dened as either spontaneous death or euthanasia
and analyzed at dierent time points: within 24 hours of presentation, after 24 hours of presentation but before 7 days after presentation, and after 7 days of presentation. For cats surviving
7 days, length of hospitalization (days) was recorded. Circumstances of death or euthanasia were classied as ATE-related
(encompassing cases where attending clinicians suspected reperfusion injury and acute kidney injury, where limb necrosis
prompted euthanasia, or where death occurred spontaneously
with no identiable cause), or related to acute or refractory dyspnea, or non-ATE and nondyspnea related. Recurrence of ATE,
survival time after presentation, and circumstances of death were
obtained by contacting owners of cats whenever this information
was not available from electronic records. For cats still alive at
the time of analysis, survival was based on the time of owner
contact or last veterinary examination.
Statistical analysis was performed by commercially available
softwarea and values are reported as median (range) for all data.

103

Univariable analyses were performed using a chi-square or Fishers Exact test for categorical variables. Continuous variables
were analyzed using a Students t-test for normally distributed
data and a Mann-Whitney U-test for non-normally distributed
data. Normality was assessed graphically and conrmed using a
Kolmogorov-Smirnov test. Factors evaluated in univariable
analysis were year of presentation, clinic, breed, sex, age, outof-hours presentation (yes/no), time to presentation (<2 hours
after onset, 26 hours after onset, 612 hours after onset,
>12 hours after onset), rectal temperature, heart rate, respiratory
rate, dyspnea (yes/no), number of limbs aected, murmur (yes/
no), gallop (yes/no), arrhythmia (yes/no), CHF (yes/no), serum
urea, creatinine, phosphate and potassium concentrations, and
treatment given (aspirin, clopidogrel, or both, heparin, furosemide: yes/no). To evaluate independent eects on survival, multivariable analysis was performed using binary logistic regression
in a backwards stepwise manner on variables with P < .1 at the
univariable level, and hazard ratios (HRs) with 95% condence
intervals (95% CI) were calculated. KaplanMeier survival curves
were generated and analyzed using a Log-Rank test. A value of
P < .05 was considered signicant.

Results
Presentation
Over the 98-month period from January 1, 2004 to
March 1, 2012, 250 cats were diagnosed with ATE in 3
clinics (74, 84, 92, respectively, in Clinics 1, 2, and 3).
The prevalence was calculated from the total number
of unique cats visiting Clinics 1 and 3. This information
was not available for Clinic 2. In these 2 clinics, 166
cats were diagnosed with a rst episode of ATE over
the 98-month studied. During the same period, 62,856
individual cats visited the 2 clinics. This equated to a
prevalence of 0.26% over the 98-month period studied.
There was no apparent seasonality to presentation of
cats with ATE: 58 presented in the Winter, 60 in
Spring, 65 in Summer, and 67 in the Fall. Whenever
the time to presentation could be determined, 95/220
cats (43.2%) were presented within 2 hours of the onset
of clinical signs and 184/220 cats (83.6%) were presented within 12 hours.

Signalment and History

Most cats were nonpedigree, comprising 230/250
(92%) cases. Pedigree breeds represented were Siamese
(4), British Shorthair (3), Burmese (3), Persian (3),
Maine Coon (2), Ragdoll (2), Bombay (1), Havana
(1), and Russian Blue (1). Males were aected in 144/
250 (57.4%) cases. The median age at presentation
was 12 years (range 121 years). The onset of clinical
signs was reported to be associated with vomiting in
27/250 (10.8%) cats. Of 221 cats without previously
diagnosed cardiomyopathy, an auscultatable abnormality (eg, murmur, gallop, arrhythmia) was detected
in 59 cats (26.7%) before presentation with
ATE (murmur, 20.8%; gallop, 2.8%; arrhythmia,
2.8%). Cardiomyopathy had been previously diagnosed in 29/250 (11.6%) cats and 17/250 (6.8%) had
been previously conrmed as hyperthyroid on the
basis of increased serum total thyroxine concentration.

104

Borgeat et al

Table 1. Limbs aected by clinical signs of ATE

(RH, right pelvic limb; LH, left pelvic limb; RF, right
thoracic limb; LF, left thoracic limb).
Limbs Aected by ATE

evidence of cardiac disease was reported in 52/97

(53.6%) cats not euthanized at presentation.

Number of Cats

Percent

Treatment

15
15
194
12
10
2
1
1

6
6
77.6
4.8
4
0.8
0.4
0.4

Analgesia was administered to all cats not euthanized at presentation (97/250). Diuretic treatment was
administered to 57/97 (58.8%) cats. Specic medical
treatment of ATE, other than analgesia, was administered in 68/97 cats (70.1%). Heparin (unfractionated
or low molecular weight) was administered alone to 21
cats and in combination with aspirin in 8 cats, with
clopidogrel in 1 cat, and with aspirin and clopidogrel
in 1 cat. Aspirin was administered alone to 25 cats and
in combination with clopidogrel in 10 cats. Clopidogrel
was used as the sole ATE-specic agent in 2 cats.

Only RH
Only LH
RH and LH
Only RF
Only LF
RH, LH, and LF
RH, LH, RF, and LF
Missing data

Of these hyperthyroid cats, 4 were not receiving treatment for their disease.

Mortality <7 Days after Presentation

Physical Examination and Diagnostic Findings

One limb was aected by ATE in 52/250 (20.8%)
cats, 2 limbs in 194/250 (77.6%), 3 limbs in 2/250
(0.8%), and 4 limbs in 1/250 (0.4%). One cat (0.4%)
did not have the number of aected limbs recorded
(Table 1). At the time of presentation, 112/250
(44.8%) cats were reported as dyspneic and 131/192
(68.2%) cats had an auscultated abnormality when
clinical data regarding cardiac auscultation were
recorded. These were an isolated heart murmur in 50
cats, isolated arrhythmia in 27 cats, isolated gallop in
27 cats, murmur and gallop in 17 cats, murmur and
arrhythmia in 8 cats, and a murmur, gallop, and
arrhythmia in 2 cats. No auscultated abnormality was
present in 61 cats and no clinical data regarding an auscultated abnormality were recorded in 58 cats. Temperature, heart rate, respiratory rate, and serum urea,
creatinine, potassium, and inorganic phosphate concentration at presentation for all cats in which data
were available are shown in Table 2. Hyperthyroidism
was newly diagnosed in 4/233 (1.7%) cats not previously known to be hyperthyroid.
At presentation, data were insucient to determine
the presence or absence of CHF in 140/250 (56%) cats.
Of cats not euthanized at presentation, sucient information was available to identify the presence or
absence of CHF in 63/97 (64.9%) cats, with CHF
present in 42 (66.7%) cats. Although echocardiography
was not performed in all cases, echocardiographic

Table 2.
Variable
Rectal temperature (oC)
Heart rate (beats/minute)
Respiratory rate (breaths/minute)
Urea concentration (mg/dL)
Creatinine concentration (mg/dL)
Phosphate concentration (mg/dL)
Potassium concentration (mEq/L)

Euthanasia was performed at presentation in 153/

250 (61.2%) cats. Of those cats for which treatment
other than euthanasia was attempted, an additional
22/97 (22.7%) cats were euthanized and 7/97 (7.2%)
cats died before 24 hours after presentation. In all, 68/
250 (27.2%) cats survived for 24 hours after presentation. Cats were more likely to be euthanized or die in
the rst 24 hours after presentation if presented outof-hours, to Clinic 2, with 2 limbs aected, or with
CHF (Table 3). Mean rectal temperature was lower in
nonsurvivors (36C [32.039.2] versus 37.8C [33.1
41.5], P < .001, Fig 1). Factors carried forward to
multivariable analysis were temperature, number of
limbs aected, CHF, clinic, and out-of-hours presentation. Independent predictors of 24-hour mortality
(euthanasia/death), identied using multivariable
analysis, were lower rectal temperature (HR, 1.44;
95% CI, 1.0022.071) and presentation to Clinic 2
(HR, 5.53; 95% CI, 1.2324.8). If Clinic 2 was
excluded from the analysis, no signicant independent
predictors of 24-hour mortality could be identied.
Of cats that survived 24 hours after presentation:
38/68 (55.9%) were dead <7 days after presentation,
32/38 were euthanized (47% of 24-hour survivors),
and 6/38 died (8.8% of 24-hour survivors). Of all cats
presenting with ATE, 30/250 (12%) survived for at
least 7 days after presentation. Of cats surviving the
initial 24 hours, those with 2 limbs aected, dyspnea,
CHF, treated with heparin, or not treated with aspirin,

Physical and laboratory ndings of cats at presentation.

Number of Cats
69
125
72
35
30
19
22

Result (Median, Range)

37.0
200
50
36.1
1.96
5.05
4.1

(32.041.5)
(80300)
(24200)
(18.2196.1)
(0.963.65)
(3.3115.5)
(2.76.1)

Reference Interval
(from Clinics 1 and 3)

Abnormal Result (%)

37.839.2
160240
1630
7.8430.8
0.452.26
2.798.05
3.55.8

62.3
16.0
90.3
68.6
26.7
5.3
27.3

Arterial Thromboembolism in 250 Cats

105

Table 3. Categorical variables signicantly associated with mortality in the initial 24 hours after presentation and
the period from 24 hours to 7 days after presentation, identied by univariable analysis (*data from Clinics 1 and
3 only).
Mortality: <24 h

Factor
Time of presentation*
Out-of-hours
In normal hours
Clinic
Clinic 2
Clinics 1 and 3
Number of limbs aected
2
1
Respiratory status
Dyspneic
Nondyspneic
Heart failure status
CHF
No CHF
Heparin
Received
Did not receive
Aspirin, clopidogrel, or both
Did not receive
Received

P Value

Mortality: 24 h but <7 days

61/84 (72.6%)
48/82 (58.5%)

.003

19/34 (55.9%)
19/34 (55.9%)

73/84 (86.9%)
109/166 (65.7%)

<.001

8/11 (72.7%)
30/57 (52.6%)

.43

158/196 (80.6%)
22/52 (42.3%)

<.001

28/38 (73.6%)
10/30 (33.3%)

.001

85/112 (75.9%)
74/113 (65.5%)

.058

19/27 (70.3%)
17/39 (43.6%)

.045

64/87 (73.6%)
4/23 (17.4%)

<.001

15/23 (65.2%)
3/19 (15.8%)

.002

P Value
1.0

n/a
n/a

n/a

18/24 (75%)
20/44 (45.5%)

.023

n/a
n/a

n/a

26/35 (74.3%)
9/33 (27.3%)

.001

Fig 1. Scatter plot to show the dierence in rectal temperature at presentation between 24-hour survivors and nonsurvivors (left) and
7-day survivors and nonsurvivors (right).

clopidogrel, or both were more likely to be euthanized

or die before 7 days (Table 3). Rectal temperature was
lower in nonsurvivors (36.8C [33.139.1] versus
38.6C [36.241.4], P = .003, Fig 1), as was age
(11 years [219] versus 13 years [121], P = .028). Factors carried forward to multivariable analysis were rectal temperature at presentation, age, CHF, number of
limbs aected, treatment with heparin, and treatment
with aspirin, clopidogrel, or both. Independent predictors of <7-day mortality were lower rectal temperature
(HR, 2.25; 95% CI, 1.124.48; P = .021) and not
receiving treatment with aspirin, clopidogrel, or both
(HR, 8.26; 95% CI, 1.3950; P = .001).

Mortality 7 Days after Presentation

Median hospitalization time for the 30 cats alive
7 days was 2 days (range 07 days). At least 1

episode of ATE recurrence was reported in 14/30

(46.7%) cats surviving for at least 7 days. Median time
from presentation to recurrence was 118 days (range
72,614 days). Euthanasia was performed at the rst
episode in 11/14 (78.6%) cats, at the second episode in
2/14 (14.3%) cats, and 1 cat was euthanized because
of a third recurrence. Euthanasia caused by clinical
signs of CHF was the cause of death in 15/30 (50%)
cats surviving 7 days. Clinical signs of ATE-related
disease, excluding recurrence, were the inciting factor
for euthanasia in 1 cat alive at 7 days; this cat suered
substantial limb necrosis. No cats in this population
were euthanized or died in association with noncardiac
or non-ATE disease.
By 1 year after presentation, 6/30 (20%) cats alive
at 7 days were still alive. For these cats, median survival time (MST) was 94 days (95% CI, 42164 days;
range 72,614; Fig 2) versus a MST of zero days

106

Borgeat et al

Fig 2. Kaplan-Meier curve to show survival in cats alive at

7 days after presentation with ATE (median survival 94 days;
95% CI, 42164 days; range 72,614 days).

(range 02,614 days) for the entire cohort (n = 250).

Log-rank survival analysis failed to identify any signicant association with survival 7 days.
Overall, the most common cause of death was
euthanasia, performed in 229/250 (91.6%) cats. Spontaneous death occurred in 16/97 (16.5%) cats that were
not euthanized at presentation.

Discussion
This retrospective study provides new information
on the prevalence of ATE in cats in a GP population.
According to these data, the prevalence was approximately 0.3% over the 98-month period studied. Our
background GP population included cats presented for
a variety of routine consultations, which may explain
the lower frequency with which ATE is reported in GP
compared with previous reports from referral practice.4,5 It is also possible that search terms used to
interrogate electronic databases, although thorough,
did not detect every case presented to the 3 clinics during the inclusion period. The prevalence calculated
from our data is likely to be representative of the
wider GP population, because the clinics participating
provided a large number of cases and represented hospitals with on-site hospitalization and diagnostic facilities and smaller branch practices with more limited
stang and resources. However, only Southern England was represented. The prevalence of feline ATE
may be dierent in other geographic regions.
As we hypothesized, euthanasia at presentation with
no attempt to treat was the most common outcome
for cats with ATE presented to GP. Nevertheless,
70.1% of cats in which treatment was attempted survived for at least 24 hours after presentation. The ability to evaluate factors associated with spontaneous
death was compromised by the large proportion of
cats euthanized in this study, particularly at presentation. In cats surviving 24 hours in which treatment
was attempted, lower rectal temperature at presentation was signicantly associated with mortality
between 24 hours and 7 days after presentation. This
nding remained signicant after multivariable analysis
that accounted for the eect of other measured variables, with an increased hazard of death of 2.25 for
every 1C lower rectal temperature.

After the initial 24-hour period, mortality within

7 days was also signicantly associated with not receiving treatment with aspirin, clopidogrel, or both. Our retrospective evidence of a treatment benet should be
interpreted with caution. Although we did identify a signicantly positive eect on outcome for cats receiving
treatment with aspirin, clopidogrel, or both in a multivariable analysis, it is possible that this was a spurious
result. The eect on outcome of early antiplatelet treatment in cats presenting acutely with ATE has not been
evaluated and merits further prospective study.
Recently, clopidogrel was reported to increase time to
ATE recurrence or cardiac death compared with aspirin
in a prospective, randomized, multicenter, clinical trial
of cats with a prior history of ATE.b
In the univariable analysis, cats with 2 limbs
aected by ATE were less likely to survive to 7 days.
This is similar to a decreased rate of survival to discharge from the hospital reported by other authors,4,8
but was not an independent predictor of mortality in
our population. Although the degree of motor function has previously been associated with outcome,4 we
did not evaluate this variable because data from multiple practitioners in multiple centers were considered
insuciently reliable.
We could not identify any signicant predictors of
mortality after 7 days in this population. In a previous
publication, the presence of CHF at presentation with
ATE was associated with a signicantly shorter median survival time.4 In our population, only 8 cats with
CHF were included in the survival analysis. Such a
low number of subjects will have decreased the likelihood of detecting a signicant dierence, should it
have existed. MST of all 30 cats surviving 7 days after
presentation was 94 days after they were presented.
Previous authors have reported the survival times of
cats discharged from the hospital,4,68 but we performed survival analysis based on cats surviving
7 days after presentation. This is likely to be a more
objective classication of patients than the point of
discharge, which may be subject to owner, veterinarian, and clinic factors.
One-year survival of cats alive at 7 days after initial presentation was 20% in this cohort. Similar numbers of patients were euthanized after discharge as a
result of CHF and ATE recurrence. The devastating
nature of ATE and CHF in cats is illustrated by the
observation that all cats alive at 7 days after presentation died or were euthanized because of cardiac disease
or factors relating to ATE.
Potential complications of ATE,4,8 such as acute
kidney injury and reperfusion injury, were dicult to
identify from available records. Although severe azotemia or hyperkalemia was reported in some patients, it
is likely that the frequency of acute metabolic abnormalities was underestimated, because of a relatively
low intensity of monitoring for patients in GP.
Because of this, we did not attempt to estimate the
rate of reperfusion injury or acute kidney injury, but
instead classied euthanasia or death in association
with severe metabolic abnormalities as ATE-related.

Arterial Thromboembolism in 250 Cats

However, it is a limitation of this study that we could

not more accurately identify these complications of
ATE within our population.
Despite a previous report suggesting seasonality in
the presentation of cats with ATE to GP, we did not
detect seasonality in our larger cohort.7 As reported
by other authors, a male bias was evident in our population of cats with ATE.4,68 Hypertrophic cardiomyopathy also has a male sex predisposition,911,15,16
which may explain the male bias in cats with
ATE. The pedigree breeds reported here are also overrepresented in reported descriptions of cardiomyopathy in cats.10,11,15
A notable dierence in signalment between this population and those previously reported was a greater
median age at presentation. Previous studies have
reported an age at presentation between 6 and
9 years,47 whereas cats in our study had a median age
of 12 years. Interestingly, univariable analysis of factors inuencing mortality after 24 hours but within
7 days suggested that nonsurvivors were younger
(11 years, 219 versus 13 years, 121). It is impossible
to explain this nding from our data. Although cats
were older, the proportion conrmed as hyperthyroid
was comparable to that previously reported.4,7,8
An interesting dierence in the historical ndings of
this population was the high frequency of previously
auscultated abnormalities. Smith et al documented previously auscultated abnormalities in only 4.7% of
cases,4 compared to 23.6% cats in this study. This
may reect greater availability of complete clinical
records in our population because cats were not
referred outside of their primary practice.
The number of cats with CHF may be underestimated
by this study, possibly because of limited diagnostic
testing performed in some clinics or because of our relatively strict criteria for the diagnosis of CHF. Accurately determining the proportion of cats with CHF at
presentation was not possible because of the high rate
of euthanasia. Of patients in which the presence or
absence of CHF could be determined, 42/63 (66.7%)
cats had conrmed CHF. The fact that diuretics were
administered to 57 cats may indicate that clinicians are
more likely to administer treatment for CHF than perform diagnostic tests to conrm its presence or that our
classication of CHF using strict criteria underestimated the true number of cats aected. The inability of
our study to determine the presence or absence of CHF
at presentation is a potential limitation.
Unfortunately, data contained in the clinical records
from multiple GP centers over a long period, which is
based on the experience and opinion of individuals, are
likely to be highly variable among clinicians and over
time. There is no way of standardizing the data in a retrospective study. There were a large number of missing
data points attributable to minimal investigation in
patients that were likely to be unstable and poorly tolerant because of stress and pain in a population in which
nancial restrictions were likely to be common. A prospective study to evaluate outcome in cats treated for
ATE, performed in a standardized manner in 1 center,

107

should eliminate most of this variation and thus

improve reliability and the strength of evidence.
In summary, the estimated prevalence of ATE in
cats presented to GP over the 98-month period studied
was 0.3%. As we hypothesized, cats with ATE presented to GP were likely to be euthanized with no
attempt to treat. Approximately, half of cats surviving
the initial 24 hours after presentation survived for
7 days. One-fth of cats alive at 7 days survived for
1 year after presentation, conrming that long-term
survival is possible in a small proportion of cases.
Corrections made after online publication November
15, 2013: errors in reported prevalence of ATE in general practice have been xed. The article previously
stated 0.003% (or 0.0026%); however, the correct
gure is 0.3% (or 0.26%).

Footnotes
a

IBM SPSS Statistics 21.0 for Windows 7, IBM (UK) Ltd,

Portsmouth, UK; GraphPad Prism 6, GraphPad Software Inc,
San Diego, CA
b
Hogan D, Fox P, Jacob K, et al. Analysis of the Feline arterial
thromboembolism: Clopidogrel vs. aspirin trial (Fat Cat). In:
Proceedings of the ACVIM Forum; June 1315, 2013; Seattle,
WA (abstract)

Acknowledgments
The authors thank the primary veterinarians for
managing these cases.
Conflict of Interest Declaration: This study was not
supported by any grant or other source of funding.
Novartis provided travel costs for Mr Borgeat to
attend ECVIM-CA Congress 2012. Dr Luis Fuentes
has performed consultancy work for Boehringher
Ingelheim.

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